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August 24, 2020

The Basic Facts about Managing Pediatric Fevers

The Basic Facts about Managing Pediatric Fevers

Back to school means back to cold and flu season, but COVID-19 is really what is at the top of every parent’s mind. This is why when your kids gets a fever, you may feel extra concerned. Rest assured that fevers were common AND confusing to ALL parents, even in the pre-pandemic days. In fact, according to Dr. Sara Kopple, “fevers used to make up almost quarter of my office visits and phone calls, yet the rules of the game can feel a little unclear for parents.” Dr. Kopple shares these general guidelines to help you navigate fevers this season.

 How do You Take an Accurate Temperature?

There are many different types of thermometers on the market, even just getting a data point is confusing.

My general rule of thumb is to advise using rectal thermometers for infants until they can no longer tolerate them.

In that toddler range, I’m ok with temporal (forehead) or tympanic (ear) scanners because of their practicality.  They may not be as accurate, but if you can get some information that way it will probably do the trick. For older kids, under the tongue is still recommended, but if cooperation is an issue the temporal or tympanic scanners are acceptable.

What Constitutes a Fever?

100.4 is my golden number to consider a temperature a fever.  I generally am not concerned when a parent tells me their child has a 99 range temperature. That to me is still considered normal.  I’ve seen some school districts are using 100 as the fever cut-off, so just make sure to check with your school system.

The big issue pre-pandemic was whether the fever is caused by a serious bacterial infection, like a UTI, meningitis or blood-borne bacteria.   Often this is what I’m trying to assess when I evaluate a child with a fever.  There is some data showing that babies have an increased risk of a serious bacterial infection when fevers go above 102 and definitely when they go above 105.  Generally, the height of the fever is not a great marker for the severity of an infection.  Common childhood summer illnesses like roseola and coxsackie cause fevers of 103 and 104 and those often have a benign course. Now of course, any fever in a child may be related to COVID-19.

When Should I call the Doctor?

In terms of when to call the pediatrician for a fever, a lot depends on your child’s age and how they appear to you generally, not just their temperature.  For newborns (usually 3 months and under) anything over 100.4 warrants a call to the pediatrician, and for 1-2 months and under, an automatic trip to the hospital may be necessary.  As kids get a little older, every fever does not require an immediate phone call to the pediatrician if the child is otherwise active, well appearing, hydrated, and without other concerning signs and symptoms, unless of course COVID needs to be ruled out.

What Treatment Should I Use for Fevers?

For children older than 6 months, the typical treatments is Acetaminophen (Tylenol) and Ibuprofen (Motrin or Advil). The goal of fever reducers is to help your child’s distress and discomfort.  The fever itself is not dangerous, it is actually the body’s response to an infection.  That said, high fevers often make kids feel down and in that case its helpful to treat them in order to improve their comfort. Many parents and providers are keen to bring down a fever as quickly as possible, but having a fever in an otherwise well appearing child is ok. The adverse effects that parents associate with fevers, like seizures, are more related to the underlying illness or infection than the fever itself.

Tylenol can be given every 4 hours and Motrin every 6 hours.  Some providers recommend alternating 1 dose of each every 3 hours, which will reduce the fever most effectively, but can also increase your risk for medication errors. It’s always handy to keep a medication log on your phone or a pad of paper, as well. I always prefer temperatures to be taken prior to medication administration to make sure there is still indeed a fever. Certainly speak with your child’s healthcare provider about the proper dosing for your child, if you are unsure.

As we head back to the school year, it is expected that fever-rules will vary from school to school. It’s important to stay informed about the current recommendations from local health authorities, and communicate with your pediatrician should you have any question or concerns about COVID-19 symptoms or exposure.